title: Clinicopathological analysis of contrast-enhanced ultrasonography using perflubutane in pancreatic adenocarcinoma.
abstract: The contrast harmonic imaging technique allows visualization of micro bubbles and has facilitated the detection of blood flow on contrast-enhanced ultrasonography (CE-US). In hypovascular tumors such as pancreatic cancer a hypoxic nutrition-deficient environment increases tumor malignancy. In this study, we investigated the relation between CE-US findings, intratumoral microvessel density (MVD), and pathological analysis in pancreatic cancer, and we also investigated the clinicopathological significance of CE-US.The subjects were 16 pancreatic cancer patients who underwent CE-US before surgery. A time-signal intensity curve (TIC) was prepared based on the region of interest (ROI) in the tumor on CE-US, and the signal intensity (SI) was defined as an increase from the value before contrast imaging to the maximum value. Regarding MVD, histological sections were stained with anti-CD34 and α-smooth muscle actin (α-SMA) antibodies, and double stained micro-blood vessels were counted. The correlation between SI and MVD was investigated. In addition, disease-free survival (DFS) was compared between the hypo (≤mean SI) and hyper (>mean SI) SI groups.SI in cancerous lesions was 54.6±42.9 dB (mean±SD), and MVD in cancerous lesions was 12.5±5.02 (mean±SD). A positive correlation was noted between the SI and MVD (r(2)=0.408, p=0.008). The median DFS were 212 and 606 days in the hypo and hyper SI groups, respectively, showing a significantly shorter DFS in the hypo SI group (P=0.003). No patient died of the primary disease during the follow-up period in the hyper SI group, and a maximum 47-month follow-up was possible. A positive correlation was noted between SI and MVD, indicating that MVD of pancreatic cancer could be evaluated using CE-US. We suggested that CE-US is a useful predictor of patient prognosis after pancreatic cancer surgery.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, Japan. akasugen@med.kurume-u.ac.jp
authors.forename: Gen
authors.initials: G
authors.lastname: Akasu
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kawahara
authors.forename: Makiko
authors.initials: M
authors.lastname: Yasumoto
authors.forename: Takenori
authors.initials: T
authors.lastname: Sakai
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Goto
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Sato
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Fukuyo
authors.forename: Koji
authors.initials: K
authors.lastname: Okuda
authors.forename: Hisafumi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
mesh_terms: D000199:Actins / Q000378:metabolism; D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D003287:Contrast Media / Q000494:pharmacology*; D018572:Disease-Free Survival; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D000860:Hypoxia; D008297:Male; D045423:Microbubbles; D008833:Microcirculation; D008875:Middle Aged; D009130:Muscle, Smooth / Q000378:metabolism; D009369:Neoplasms / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D013997:Time Factors; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods*
chemical_list: D000199:Actins; D018952:Antigens, CD34; D003287:Contrast Media; D005466:Fluorocarbons; C108042:perfluorobutane